Department of Interventional Radiology, Mount Sinai Medical Center, New York, NY 10029, USA.
J Vasc Interv Radiol. 2013 Jan;24(1):49-55. doi: 10.1016/j.jvir.2012.09.022.
To review the effect of preoperative embolization of the inferior mesenteric artery (IMA) before endovascular aneurysm repair (EVAR) on subsequent endoleaks and aneurysm growth.
Between August 2002 and May 2010, 108 patients underwent IMA embolization before EVAR. Coil embolization was performed in all patients in whom the IMA was successfully visualized and accessed during preoperative conventional angiography. In this cohort, the incidences of type II endoleak, aneurysm sac volume enlargement at 24 months, and repeat intervention were compared with a group of 158 consecutive patients with a patent IMA on preoperative computed tomography angiography but not on conventional angiography, who therefore did not undergo preoperative embolization.
The incidence of type II endoleak was significantly higher in patients not treated with embolization (49.4% [78 of 158] vs 34.3% [37 of 108]; P = .015). The incidence of secondary intervention for type II endoleak embolization was also significantly higher in those who did not undergo embolization (7.6% [12 of 158] vs 0.9% [one of 108]; P = .013). At 24 months, an increase in aneurysm sac volume was observed in 47% of patients in the nonembolized cohort (21 of 45), compared with 26% of patients in the embolized cohort (13 of 51; P = .03). No aneurysm ruptures or aneurysm-related deaths were observed in either group. One patient in the embolization group developed mesenteric ischemia and ultimately died.
Preoperative embolization of the IMA was associated with reduced incidences of type II endoleak, aneurysm sac volume enlargement at 24 months, and secondary intervention.
回顾肠系膜下动脉（IMA）术前栓塞对血管内动脉瘤修复（EVAR）后内漏和动脉瘤生长的影响。
2002 年 8 月至 2010 年 5 月，108 例患者接受了 EVAR 前 IMA 栓塞。所有患者均成功进行了术前常规血管造影显示和进入 IMA 的线圈栓塞。在这组患者中，与一组 158 例术前 CT 血管造影显示 IMA 通畅但常规血管造影显示不畅通且未行术前栓塞的连续患者相比，比较了 II 型内漏、24 个月时动脉瘤囊体积增大以及再次介入的发生率。
未行栓塞治疗的患者 II 型内漏发生率明显较高（49.4%[78/158]比 34.3%[37/108]；P=.015）。未行栓塞的患者中，因 II 型内漏进行二次介入治疗的发生率也明显较高（7.6%[12/158]比 0.9%[1/108]；P=.013）。在未栓塞组中，47%的患者（21/45）在 24 个月时观察到动脉瘤囊体积增大，而栓塞组中这一比例为 26%（13/51；P=.03）。两组均未发生动脉瘤破裂或与动脉瘤相关的死亡。栓塞组中有 1 例患者发生肠系膜缺血，最终死亡。
IMA 术前栓塞与 II 型内漏发生率降低、24 个月时动脉瘤囊体积增大和二次介入相关。
